Covid-19 - Facts and Information Only thread

[This is a general message. If you see it, please don't take it personally]
To avoid creating another mega-thread, I am returning to edit previous posts:

-update them with current information as it emerges or to add better information, so check back to the same post.

-paste in comments from knowledgable people that were originally separate posts

-delete discussion

If you want to discuss, please use the other thread. On a computer, click on the post date-time in the upper left corner to obtain a direct link to the post in question, then copy a link to include in your post so people know what you're referencing. On a mobile device, this can be done but instructions vary.

If you find updated info, feel free to post it - but your post may disappear as I merge your info into the relevant original post. I try to quote and give credit.

Thanks, and again - please don't take it personally if your post is deleted, I'm trying to maintain a succinct thread for information and resources. The other thread is there for your Covid-19 discussions and ruminations.

A Phoenix-area man has died and his wife was in critical condition after the couple took chloroquine phosphate, an additive used to clean fish tanks that is also found in an anti-malaria medication that’s been touted by President Donald Trump as a treatment for COVID-19.

But there have been considerable numbers of cases in tropical regions, too. A recent analysis of the spread of the virus in Asia by researchers at Harvard Medical School suggests that this pandemic coronavirus will be less sensitive to the weather than many hope.

They conclude that the rapid growth of cases in cold and dry provinces of China, such as Jilin and Heilongjiang, alongside the rate of transmission in tropical locations, such as Guangxi and Singapore, suggest increases in temperature and humidity in the spring and summer will not lead to a decline in cases. They say it underlines the need for extensive public health interventions to control the disease."

IOW, we hope it will decline, but there are indications that it will not especially while it is in a pandemic mode of person to person spread.]

"But the true danger of coronavirus is unlikely to be the death toll. Experts say health systems could easily become overwhelmed by the number of cases requiring hospitalisation – and, often ventilation to support breathing. An analysis of 45,000 confirmed cases in China, where the epidemic originated, show that the vast majority of deaths were among the elderly (14.8 percent mortality among over 80s).

But another Chinese study showed that 41 percent of serious cases occurred among under 50s, compared with 27 percent among over 65s.

"It's true that if you're older you're at greater risk, but serious cases can also happen in relatively young people with no prior conditions," said French deputy health minister Jerome Salomon."

Repeat that again: 41 percent of serious cases requiring hospitalization or even critical care, occurred among people under 50. And they did not all have prior conditions.

"But the true danger of coronavirus is unlikely to be the death toll. Experts say health systems could easily become overwhelmed by the number of cases requiring hospitalisation – and, often ventilation to support breathing. An analysis of 45,000 confirmed cases in China, where the epidemic originated, show that the vast majority of deaths were among the elderly (14.8 percent mortality among over 80s).

But another Chinese study showed that 41 percent of serious cases occurred among under 50s, compared with 27 percent among over 65s.

"It's true that if you're older you're at greater risk, but serious cases can also happen in relatively young people with no prior conditions," said French deputy health minister Jerome Salomon."

Repeat that again: 41 percent of serious cases requiring hospitalization or even critical care, occurred among people under 50. And they did not all have prior conditions.

Any idea how many did have prior conditions/risk factors? As China has the largest smoking population in the world. Accounting for 40% of all tobacco smoked in the world. It isn’t like the US is the picture of health with our obesity problem. But I do wonder, and have not been able to find, what the risk is to a totally healthy person. I’m talking 20-30, who doesn’t smoke, doesn’t drink, exercises regularly, isn’t obese, and has no pre-existing conditions. I really want to see that data and have yet to find it. Especially because in America you are considered healthy if you aren’t morbidly obese. To me, healthy is exercising regularly and eating right. Most Americans definition is far different it seems.

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Any idea how many did have prior conditions/risk factors? As China has the largest smoking population in the world. Accounting for 40% of all tobacco smoked in the world. It isn’t like the US is the picture of health with our obesity problem. But I do wonder, and have not been able to find, what the risk is to a totally healthy person. I’m talking 20-30, who doesn’t smoke, doesn’t drink, exercises regularly, isn’t obese, and has no pre-existing conditions. I really want to see that data and have yet to find it. Especially because in America you are considered healthy if you aren’t morbidly obese. To me, healthy is exercising regularly and eating right. Most Americans definition is far different it seems.

There is only limited data available at present. Understandably, the focus in China has been on treating the epidemic and containing the disease. Same in Italy, same in the places of US that are currently slammed with cases such as NYC, Seattle, SF, LA. If someone tries to get them to put together such data right now, they will be understandably told to go "take a tall walk under a short bridge"

The case fatality rate in China, including at the height of the epidemic, is 0.9% for people "without co-morbid conditions" (all ages). That doesn't sound too bad, and it's probably primarily applicable to young people because it's a relatively rare person >60 yrs who doesn't have at least one co-morbid condition.

But I think what you - and maybe other young healthy folks - would like to know, is the morbidity of covid-19 among people without co-morbid conditions? How likely are they to develop severe disease and be hospitalized for several weeks? How likely are they to become critically ill and require care on a ventilator? Basically, as a healthy young guy with no comorbid conditions, should you feel a sense of personal invincibility?

The answer to my knowledge right now, is we just don't know. People on the front lines of this thing are saying that they see young, previously healthy people coming in seriously or critically ill. The best data is that right now, 40% of those being hospitalized are between 20-54. That is an age group where comorbid conditions in the US are relatively rare, so it is doubtful that all of those people have comorbid conditions. And they are getting stinkin', nasty, debilitatingly sick.

They're not the ones I'm worried about actually. I'm worried about the ones who don't feel feverish enough to seek a thermometer (if they can find one), maybe a bit of a headache and sore throat - NBD - so absent restrictions they flit around shedding covid-19 virus.

By the way, obesity or overweight aren't listed as comorbid conditions in the data from China. On the other hand in China obesity is relatively rare.

If you do find such data, feel free to share.

I just want to link some data upthread showing the difference between morbidity and mortality in China.

We can see that while the mortality rate is highest in the elderly (and the older the higher), a substantial number of young people were diagnosed - and keep in mind at this stage in the epidemic (they are now up over 81,591 cases), diagnosis was skewed towards seriously ill people and they weren't yet contact tracking and testing everyone.

By the way, even with our extremely limited testing, we will probably pass China in case count by Thurs. or Fri.

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There is only limited data available at present. Understandably, the focus in China has been on treating the epidemic and containing the disease. Same in Italy, same in the places of US that are currently slammed with cases such as NYC, Seattle, SF, LA. If someone tries to get them to put together such data right now, they will be understandably told to go "take a tall walk under a short bridge"

The case fatality rate in China, including at the height of the epidemic, is 0.9% for people "without co-morbid conditions" (all ages). That doesn't sound too bad, and it's probably primarily applicable to young people because it's a relatively rare person >60 yrs who doesn't have at least one co-morbid condition.

But I think what you - and maybe other young healthy folks - would like to know, is the morbidity of covid-19 among people without co-morbid conditions? How likely are they to develop severe disease and be hospitalized for several weeks? How likely are they to become critically ill and require care on a ventilator? Basically, as a healthy young guy with no comorbid conditions, should you feel a sense of personal invincibility?

The answer to my knowledge right now, is we just don't know. People on the front lines of this thing are saying that they see young, previously healthy people coming in seriously or critically ill. The best data is that right now, 40% of those being hospitalized are between 20-54. That is an age group where comorbid conditions in the US are relatively rare, so it is doubtful that all of those people have comorbid conditions. And they are getting stinkin', nasty, debilitatingly sick.

They're not the ones I'm worried about actually. I'm worried about the ones who don't feel feverish enough to seek a thermometer (if they can find one), maybe a bit of a headache and sore throat - NBD - so absent restrictions they flit around shedding covid-19 virus.

By the way, obesity or overweight aren't listed as comorbid conditions in the data from China. On the other hand in China obesity is relatively rare.

If you do find such data, feel free to share.

Excellent post sir. That is exactly what I’m wondering. I see some people reported as being healthy coming ill. It’s making me wonder if healthy is simply without pre-existing conditions though. Someone could be considered “healthy” simply because they aren’t obese. But to me, my definition of healthy is not only that, but someone who exercises quite regularly, eats right, things of that nature. But, as you said; I think the data is just too new to collect these exacting variables yet.

The model assumes 20% of infected patients need hospitalization (data from China/India). As far as I can tell, it does not separate out ICU beds.

The article has a place where you can enter your location to view hospital capacity near you.

Key quote:

"In the Harvard team’s moderate scenario — where 40% of the adult population contracts the disease over the course of a year — 98.9 million Americans would develop the coronavirus, though many will have mild or no symptoms, and will not have their diagnoses confirmed by tests. Slightly more than a fifth of all cases will require hospitalization. (That’s roughly the average number of patients requiring hospitalization in other countries.) To treat all hospitalized patients over that time, the country would have to more than double available hospital beds by freeing up existing beds or adding new ones. If that moderate estimate holds, about a fifth of hospitalized patients, or nearly 5% of those infected, would become critically ill from COVID-19 and would need intensive care, such as the use of a ventilator.

If all existing ICU beds are freed up for COVID-19 patients, the total capacity would have to be increased 74%. And even then, hospitals may have a limited supply of ventilators and specialized staff who can care for extreme cases. In the researchers’ worst-case scenario — if 60% of the population falls sick and the virus spreads within six months — the nation would require more than seven times the number of available hospital beds that it currently has."

Without effective, uniform containment measures and social distancing, the 40%/6 month scenario is more likely right
Let's pick a random locale:

What we see is that >200% of beds would be filled in that scenario. If people age 20-54 are 40% of the hospitalizations, what we see is that even if everyone over 70 is triaged and denied hospital care (a scenario I don't care to think about), there are going to be people in the age group of prime working adults who will either not get care, or not get optimal care (don't forget, HCW will be falling ill and less staff will be available per patient).

In most scenarios, “vast communities in America are not prepared to take care of the COVID-19 patients showing up,” said Dr. Ashish Jha, director of the Harvard Global Health Institute, who led a team of researchers that developed the analysis.

Under the researchers’ best-case scenario, Americans will act quickly to slow the spread of the virus through social distancing, and the infection rate among adults will remain relatively low at 20%, or 49.4 million people over the age of 18, less than twice the number of people who get the flu each year.

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Excellent post sir. That is exactly what I’m wondering. I see some people reported as being healthy coming ill. It’s making me wonder if healthy is simply without pre-existing conditions though. Someone could be considered “healthy” simply because they aren’t obese. But to me, my definition of healthy is not only that, but someone who exercises quite regularly, eats right, things of that nature. But, as you said; I think the data is just too new to collect these exacting variables yet.

This is anecdotal (references two young healthy people), but I thought it was interesting. (should be available without paywall)

I thought it was interesting because she specifically mentions "I don’t have any prior autoimmune or respiratory conditions. I work out six times a week, and abstain from cigarettes." Judging by her picture she is at an appropriate weight.

So my best guess is that of course, overall, being in good physical shape and good health will always give one an advantage, but there may be some susceptibility we don't yet understand in what people this virus can attack most severely (I know, I said facts, but we have none here.)

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This is anecdotal (references two young healthy people), but I thought it was interesting. (should be available without paywall)

I thought it was interesting because she specifically mentions "I don’t have any prior autoimmune or respiratory conditions. I work out six times a week, and abstain from cigarettes." Judging by her picture she is at an appropriate weight.

So my best guess is that of course, overall, being in good physical shape and good health will always give one an advantage, but there may be some susceptibility we don't yet understand in what people this virus can attack most severely (I know, I said facts, but we have none here.)

Wanted to post some quotes from the article:

Quote

I’m 26. I don’t have any prior autoimmune or respiratory conditions. I work out six times a week, and abstain from cigarettes. I thought my role in the current health crisis would be as an ally to the elderly and compromised. Then, I was hospitalized for Covid-19.

Quote

That night I woke up in the middle of the night with chills, vomiting, and shortness of breath. By Monday, I could barely speak more than a few words without feeling like I was gasping for air. I couldn’t walk to the bathroom without panting as if I’d run a mile. On Monday evening, I tried to eat, but found I couldn’t get enough oxygen while doing so. Any task that was at all anxiety-producing — even resetting my MyChart password to communicate with my doctor — left me desperate for oxygen.

Quote

While I was shocked at the development of my symptoms and my ultimate hospitalization, the doctors and nurses were not at all surprised. After I was admitted, I was told that there was a 30-year-old in the next room who was also otherwise healthy, but who had also experienced serious trouble breathing. The hospital staff told me that more and more patients my age were showing up at the E.R. I am thankful to my partner for calling the hospital when my breathing worsened, and to the doctor who insisted we come in. As soon as I received an oxygen tube, I began to feel slight relief. I was lucky to get to the hospital early in the crisis, and receive very attentive care.

[Edit: Thanks. In general, I want to keep this thread for more widely applicable info about covid-19, but I I think one of the most dangerous misconceptions people have about covid-19 is to look at the age distribution of deaths, and conclude therefore young people don't become seriously, dangerously, debilitatingly ill. We lack exact statistics but they can and do, and it's a significant number - as you quoted "the doctors and nurses were not surprised"]

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Wow...this is a game changer but it appears currently only in the UK? Basically an at home test that provides results in 15 minutes as to whether you have antibodies built up against coronavirus(ie, have already had it). Planning to test millions of people and if a large portion have antibodies it means they already had it with minor or no symptoms. Which then means they will know how quickly they can resume normalcy... Some models predict that there are already millions of tens of millions of people infected and others that predict half the UK already has gotten it...

This will basically allow those who have already had it to resume normal life without fear of getting it again...could really help with letting us know not only how dangerous this situation is and more importantly who would be in danger...

Pump the brakes here, Son.

First off, please search the thread for info before posting. The Scanwell test is discussed here, along with Biomedomics antibody test which is currently in use in China:

If it works like the Biomedomics test in use in China or the Scanwell test, it detects innate immunity response (IgM) and adaptive immunity response (IgG). The Biomedomics test is designed like a Pg test, with two lines. You prick your finger and apply a drop of blood, then developer. 15 minutes later, you read.

Here are the caveats:
1) As a diagnostic test, antibody response has a built-in lag - someone will be infected and potentially infectious for a few days before antibodies develop. So someone who tests negative, could still be infected and infectious.
2) The Biomedomics test and I think the Scanwell test, had a significant false-negative (maybe for this reason) and false-positive rate (10-12%). Pay attention to the false positive rate if you're determining who is "free to move about the country". 1 in 10 people tested could still be susceptible.
3) IgM doesn't mean you're permanently immune. It's an early immune response, a few days after exposure to a disease
4) Someone displaying IgG response, may still have active disease! Even someone who has recovered from symptoms, may still, in fact, be infectious! Viral shedding has been observed for several weeks after symptoms resolve - I think in one case 31 days.

So to be cleared to resume normal life, a person must be tested both serologically (to see if they've developed immunity) AND tested for viral RNA to be sure they aren't infectious.

The Biomedomics test is being widely used in China during contact tracing. Even with the false-negative and false-positive rate, I think it would be very useful here. But I wouldn't quite describe it as a "game changer", for the reason of viral shedding as described above.

It is notable that China is requiring two weeks of home isolation after discharge and follow-up RT-PCR testing of sputum and stool, because of the observation of viral shedding. See XVII (3) at this link:
This is not (yet) part of the CDC recommendations (we seem determined to re-invent the wheel here, and so does UK)

It highlights what I see as the problem with this disease - the morbidity (how many people get sick enough to need hospital care, what level of care they need, and for how long). Simply talking about case fatality rate doesn't address this. We don't have a lot of data on this, but for some reason a number of experts don't seem to be taking this into account.

Some basic math: If the virus overall has <1% death rate, well and good - though 0.5% is still 0.987 million Americans given a 60% infection rate. But if that ASSUMES that everyone who needs it is able to access the best level of medical care. If they can't, then as we have seen from the initial outbreak in Wuhan and in Italy and Spain, the death rate is higher. As we can see from the above model, it simply won't be true in many of the most populous regions of the country that patients can access the best level of health care, if the virus travels quickly.

Note that you can multiply their assumption of 20% need hospital care (based on China's experience with 70,000 cases) by the infection rate, and ANY secenario that matches that number should apply. IE the lower left panel (20% infected, 20% need hospital care) would also match 40% infected, 10% need hospital care.

Again, the model does not address ICU beds, which are non-existent in many large swathes of rural areas. Considering these, the map would color differently.

For sanity check, best data are that seasonal influenza (which is not as infectious due to lower R0 and shorter incubation time) is believed to infect 10-30% of Americans annually (30 million-100 million).

"Aerosols are different," says Dr. Stanley Deresinski, clinical professor of medicine and infectious diseases at Stanford University. "Very small particles may be suspended in the air for a long time, sometimes for hours. They're suspended by air currents."

Airborne droplets can stay suspended long enough for someone to walk through and inhale the virus. Outdoors, wind disperses the virus.

A virus that doesn't reach the ground or floor can fall on shared surfaces – or be transferred there by those with the pathogen on their hands. Whatever the case, unsuspecting people can pick it up. How long a virus lives depends on the surface it's on..."

[Good article, Exiled. It summarizes the findings of the NE Journal of Medicine article linked in one of the OPs, but in a nice, readable way with pictures. One comment is that they kind of imply that when someone coughs, or even breathes forcefully, they produce droplets that don't stay suspended. That's largely true. But it's my understanding that coughing has been studied to produce some aerosols as well, which is why there is still some risk for obsessive handwashers, going out and staying 6 feet away from everyone - especially in an enclosed space with relatively poor air exchange. Outside much less issue.

It's for this reason that public health experts in several Asian countries push the wearing of masks in public - if you're sick, stuff should stay inside the mask (in theory, if you do things right)]